Tag: vicarious menstruation

“Mrs Wilson’s Case”, undated and unsigned, appears in the final volume of Hans Sloane’s Medical Correspondence and Cases (Sloane MS 4078, f. 372). Mrs Wilson’s troubles began the previous spring. She noticed in May that her tongue was occasionally sore when she ate, which she assumed must have been the result of a loose tooth cutting it. An obvious conclusion, with a seemingly obvious treatment: having the tooth pulled. But she waited until July before taking “a Friends Advice” to do just that.

Watercolour drawing of a Hunterian chancre situated on the dorsum of the tongue, 1892. The patient was a young woman, aged 22. Credit: St Bartholomew’s Hospital Archives & Museum, Wellcome Images.

Mrs Wilson’s tongue continued to worsen and she called in “an old experienced surgeon”, who prescribed medicinal gargles of all kinds. By August, it was clear that the gargles were not helping. Mrs. Wilson had a noticeable ulcer on her tongue. This time, the surgeon prescribed other remedies to treat internal blockages, possibly caused by a scorbutic or venereal problem. He gave her mild mercurial pills and purges.[1] He salivated her.[2] He applied a seton to the back of her neck.[3] He gave her a linctus.[4]

Nowadays, we might think these sorts of remedies were overkill in treating a mere mouth ulcer, when surely a topical treatment like Bonjela would do the trick! But the use of the term “ulcer” to describe Mrs Wilson’s problem is misleading for modern readers; in early modern usage, “ulcer” referred specifically to an open sore that seeped morbid matter. This was a much more serious problem. She had other symptoms, too, such as a pinching in her throat and pain in her ear and head. The swelling of her tongue kept increasing.

During treatment, the sore had been “ebbing and flowing”, which initially gave some hopes of a cure, but when a fungus developed over it, the surgeon “confessed it to be a discouraging case”. He consulted a second surgeon, who seemed to have more success. The fungus cleared up within a week, allowing the second surgeon to focus once more on the ulcer—at least until the fungus reappeared within a fortnight. This was treated quickly, but the fungus again returned again two weeks later, and started to spread up the tongue. This was becoming cyclical. Another fortnight passed, at which point both surgeons decided to consult Sloane.

One section of the case, marked “N.B.” to indicate its importance, explained that the salivation had “brought her Courses [menstruation] uopn her before the Time, but she has never had them since.” Indeed, the situation took an odd turn: “Some time after the salivation the Tongue voided Blood wch the old surgeon acknowledged might be the Courses flowing to the Part & bled her in the Foot.” Mrs Wilson had since been bled twice, but “the Blood continues to flow thither periodically”.

Mrs Wilson, it appeared, was menstruating through her tongue. This process, known as vicarious menstruation, has been neatly described in a blog post by Helen King: nature seeking an alternative path out of a woman’s body when her menstrual flow was suppressed. The dominant explanation for menstruation was that the body needed to purge itself of a plethora of blood, which men ordinarily excreted through sweat; plethora would continue to build up in a person’s body, leading to a variety of health problems if it was not released. Common forms of vicarious menstruation included nosebleeds, coughing up blood, or bleeding haemorrhoids.[5] These alternative flows might have been ‘natural’, but they certainly weren’t desirable; the new pathways had been created by the acidity of the stagnant, corrupted mass of blood.

So what did the eminent physician Sloane think? His response is cryptically indicated by the prescription that he scrawled on the top of the page in two lines of Latin abbreviations. He agreed with some of the first surgeon’s treatments, recommending first that Mrs Wilson be bled from the foot. This was a common method of drawing down a woman’s menstruation and re-establishing its correct path. He also aimed to treat the corrupted blood, which was causing the ulcer, by means of a cathartic electuary (a strong purge). Sloane, however, may have been a bit sceptical about the mercurial treatments, as suggested by his prescription for gold powder—a treatment to counteract mercury poisoning.

The tongue itself was an unusual location for vicarious menstruation, but certainly not impossible: any open sore offered a potential exit for retained blood. Helen King wondered in her blog post how patients suffering from vicarious menstruation might have reacted. Mrs Wilson’s case describes her physical pains, as well as the discouragement of the first surgeon, which hints at her experience. But perhaps the simple list of symptoms is evocative enough: swollen tongue, ulcer, fungal growth and periodically bleeding tongue. Enough said. It puts my teeth on edge.

[1] Mercury was used to treat venereal and scorbutic problems, which were thought to result from a hot, poisonous humour.

[2] A treatment that aimed to drain bad humours of the body through a continuous flow of saliva.

[3] A small surgical hole in the skin, kept open to allow drainage of bad humours.

[4] A cough medicine, presumably in this case an expectorant one to expel the phlegm in the lungs.